The issue of air travel following surgical intervention is becoming an increasingly important
issue with the wider use of day surgery.
It should be kept in mind that post-operative patients are in a state of increased oxygen
consumption due to the trauma of surgery, the increased adrenergic outflow and the possible
presence of sepsis.
Concurrently, oxygen levels may be decreased or fixed in patients who are:
Consequently, for such patients it would be wise to delay air travel for several days or request
oxygen to be provided. With the decreased use of blood transfusion, many post-operative patients
are more anaemic than they have been in the past. It is not uncommon to see young patients with
haemoglobins of the order of 7 g/dl and elderly patients with haemoglobins of approximately 8 g/dl
(see also our information concerning Haematological Disorders).
It is important to remember that intestinal gas will expand by approximately 30% by volume at a
cabin altitude of 8,000 feet. Many post-abdominal surgery patients have a relative ileus for some
days, thereby putting them at risk of tearing suture lines, bleeding or indeed, in extreme
circumstances perforation. Stretching intestinal or gastric mucosa may also result in
To avoid such complications, travel should be avoided for 10 days following abdominal surgery.
Following other procedures, such as colonoscopy where a large amount of gas has been introduced
into the colon, it is advisable to avoid travel by air for 24 hours. Similarly, it is advisable to
avoid flying for approximately 24 hours after laparoscopic intervention, due to the residual CO2
gas, which may be in the intra-abdominal cavity.
Neurosurgical intervention may leave gas trapped within the skull, which again may expand at
altitude. It is therefore advisable to avoid air travel for approximately 7 days following this
type of procedure.
Ophthalmological procedures for retinal detachment also involve the introduction of gas by
intra-ocular injections, which temporarily increase intra-ocular pressure. Depending on the gas, it
may be necessary to delay travel for approximately 2 weeks if sulphur hexafluoride is used and 6
weeks with the use of perfluoropropane. For other intra-ocular procedure and penetrating eye
injuries, 1 week should elapse before flying.
Following the application of a plaster cast, the majority of airlines restrict flying for 24
hours on flights of less than 2 hours or 48 hours for longer flights. This is principally due to
the risk of circulatory impairment as a result of tissue swelling, particularly in lower limb
injuries if the leg cannot be elevated during travel. If there is an urgent need for travel before
these limits, the plaster cast may be bivalved. If a pneumatic splint is used, some air should be
released to allow for gaseous expansion at altitude, which could cause discomfort as well as
potential circulatory compromise or neuropraxia.
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